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Antibiotics for preventing complications in children with measles

Measles is an infectious disease caused by a virus. There is an effective vaccine which can prevent measles, nevertheless 30 to 40 million people worldwide still develop measles annually. Each year measles causes more than half a million deaths and is responsible for an estimated 44% of the 1.7 million vaccine-preventable deaths among children. Measles is associated with complications such as pneumonia, ear infections, throat infections, diarrhea and conjunctivitis.

Currently, the administration of two doses of vitamin A is recommended for the prevention of these complications in children below two years of age. Another method to prevent post-measles complications is to give antibiotics to children. The objective of this review was to assess the effects of antibiotics given to children with measles to reduce pneumonia, other morbidities and mortality. This review contains search results from May 2013 and included seven controlled clinical trials (1263 children), showed that children with measles who were given antibiotics had a lower incidence of pneumonia, ear infections and tonsillitis. However, there were no benefits for conjunctivitis or gastroenteritis. No major side effects attributable to administration of the study drugs were observed. As many of the studies were performed five decades ago with weak methodology using old antibiotics, there is a need for randomized controlled trials using newer antibiotics.

Authors' conclusions:

The studies reviewed were of poor quality and used older antibiotics. This review suggests a beneficial effect of antibiotics in preventing complications such as pneumonia, purulent otitis media and tonsillitis in children with measles. On the basis of this review, it is not possible to recommend definitive guidelines on the type of antibiotic, duration or the day of initiation. There is a need for more evidence from high-quality RCTs to answer these questions.

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Background:

Measles is the leading killer among vaccine-preventable diseases; it is responsible for an estimated 44% of the 1.7 million vaccine-preventable deaths among children annually.

Objectives:

To assess the effects of antibiotics given to children with measles to prevent complications and reduce pneumonia, other morbidities and mortality.

Search strategy:

We searched CENTRAL 2013, Issue 4, MEDLINE (1966 to May week 4, 2013) and EMBASE (1980 to May 2013).

Selection criteria:

Randomised controlled trials (RCTs) and quasi-RCTs comparing antibiotics with placebo or no treatment, to prevent complications in children with measles.

Seven trials with 1263 children were included. The methodological quality of most studies was poor. Only two studies were randomized, double-blind trials. There was variation in antibiotics used, their doses, schedule and evaluation of outcome. Pooled studydata showed that the incidence of pneumonia was lower in the treatment group compared to the control group. However, the difference was not statistically significant. Of the 654 children who received antibiotics, 27 (4.1%) developed pneumonia; while out of 609 children in the control group, 59 (9.6%) developed pneumonia (odds ratio (OR) 0.35; 95% confidence interval (0.12 to 1.01). The one trial that showed an increase in the rate of pneumonia with antibiotics was conducted in 1942 and compared oral sulfathiazole with symptomatic treatment. If the results of this trial are removed from the meta-analysis, there is a statistically significant reduction in the incidence of pneumonia in children receiving antibiotics (OR 0.26; 95% CI 0.12 to 0.60). The incidence of other complications was significantly lower in children receiving antibiotics: purulent otitis media (OR 0.34; 95% CI 0.16 to 0.73) and tonsillitis (OR 0.08; 95% CI 0.01 to 0.72). There was no difference in the incidence of conjunctivitis (OR 0.39; 95% CI 0.15 to 1.0), diarrhea (OR 0.53; 95% CI 0.23 to 1.22) or croup (OR 0.16; 95% CI 0.01 to 4.06). No major adverse effects attributable to antibiotics were reported.

For 20 years, Cochrane has produced systematic reviews of primary research in human health care and health policy, and these are internationally recognized as the highest standard in evidence-based health care resources. Read more...